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J85.1 ICD-10-CM Code: Abscess of lung with pneumonia

Compare with another code for J85.1Check this code on a claim

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 use-additional code · 1 code-also instruction
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 115

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Use additional codefrom J85Report with this code when documented
  • Use additional code (B95-B97) to identify infectious agent.
Code alsoMay be needed with this code
  • the type of pneumonia

Where it sits Source: CMS/NCHS

Under:Chapter 10: Diseases of the Respiratory SystemJ85-J86 Suppurative and necrotic conditions of the lower respiratory tractJ85 Abscess of lung and mediastinum

CompareCheck ClaimView Related Codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 177 — RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC (MDC 04)
  • MS-DRG 178 — RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC (MDC 04)
  • MS-DRG 179 — RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC (MDC 04)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 283 — Empyema, Lung Abscess

Other models: CMS-HCC V22 HCC 115

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for J85.1 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on J85.1 itself; “inherited from” names the category or block whose note applies here.

Code Also

Additional codes that may be required to fully describe the encounter.

  • the type of pneumonia

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code (B95-B97) to identify infectious agent.

Source: inherited from J85

Coder workflow for J85.1

MedCoder structured workflow — derived from this code’s own official record

Before you code J85.1

  1. J85.1’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Use Additional Code — after identifying J85.1(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with J85.1 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    See the official tabular notes · Guidelines I.A.13

  • Code Also — related condition(1 note)

    Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

    See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is J85.1 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with J85.1?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Abscess of lung with pneumonia is a billable ICD-10-CM diagnosis code (J85.1).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Verify Before Coding

  • MCC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name J85.1 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: J86 — Pyothorax (via J85.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: J18 — Pneumonia, unspecified organism.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code First instruction: I76 — Septic arterial embolism (via J85.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Referenced by 9 Code Also instructions: J09.X1 — Influenza due to identified novel influenza A virus with pneumonia, J10.0 — Influenza due to other identified influenza virus with pneumonia, J11.0 — Influenza due to unidentified influenza virus with pneumonia, J12 — Viral pneumonia, not elsewhere classified, J13 — Pneumonia due to Streptococcus pneumoniae, J14 — Pneumonia due to Hemophilus influenzae, J15 — Bacterial pneumonia, not elsewhere classified, J16 — Pneumonia due to other infectious organisms, not elsewhere classified, J17 — Pneumonia in diseases classified elsewhere.

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 22 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 5 MS-DRGs: DRG 177 (MDC 04), DRG 178 (MDC 04), DRG 179 (MDC 04), DRG 791 (MDC 15), DRG 793 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):RSP002 — Pneumonia (except that caused by tuberculosis) (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

A15.0 — Tuberculosis of lung, A15.4 — Tuberculosis of intrathoracic lymph nodes, A15.5 — Tuberculosis of larynx, trachea and bronchus, A15.6 — Tuberculous pleurisy, A15.8 — Other respiratory tuberculosis, A15.9 — Respiratory tuberculosis unspecified, A17.9 — Tuberculosis of nervous system, unspecified, A18.82 — Tuberculosis of other endocrine glands, A18.84 — Tuberculosis of heart, A18.89 — Tuberculosis of other sites, J22 — Unspecified acute lower respiratory infection, J85.0 — Gangrene and necrosis of lung, J85.2 — Abscess of lung without pneumonia, J98.8 — Other specified respiratory disorders, J98.9 — Respiratory disorder, unspecified, N80.B1 — Endometriosis of pleura, N80.B2 — Endometriosis of lung, N80.B31 — Superficial endometriosis of diaphragm, N80.B32 — Deep endometriosis of diaphragm, N80.B39 — Endometriosis of diaphragm, unspecified depth, +1 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Empyema, Lung Abscess) for risk-adjusted payment.

A06.5 — Amebic lung abscess, J85.0 — Gangrene and necrosis of lung, J85.2 — Abscess of lung without pneumonia, J85.3 — Abscess of mediastinum, J86.0 — Pyothorax with fistula, J86.9 — Pyothorax without fistula

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Aspiration and Specified Bacterial Pneumonias

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Pneumonia (except that caused by tuberculosis)).

J15.211 — Pneumonia due to Methicillin susceptible Staphylococcus aureus, J15.212 — Pneumonia due to Methicillin resistant Staphylococcus aureus, J15.29 — Pneumonia due to other staphylococcus, J15.3 — Pneumonia due to streptococcus, group B, J15.4 — Pneumonia due to other streptococci, J15.5 — Pneumonia due to Escherichia coli, J15.6 — Pneumonia due to other Gram-negative bacteria, J15.61 — Pneumonia due to Acinetobacter baumannii, J15.69 — Pneumonia due to other Gram-negative bacteria, J15.7 — Pneumonia due to Mycoplasma pneumoniae, J15.8 — Pneumonia due to other specified bacteria, J15.9 — Unspecified bacterial pneumonia, J16.0 — Chlamydial pneumonia, J16.8 — Pneumonia due to other specified infectious organisms, J17 — Pneumonia in diseases classified elsewhere, J18.0 — Bronchopneumonia, unspecified organism, J18.1 — Lobar pneumonia, unspecified organism, J18.8 — Other pneumonia, unspecified organism, J18.9 — Pneumonia, unspecified organism, J95.851 — Ventilator associated pneumonia, +48 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Abscess”, “Pneumonia”; these codes share that main term but sit in a different category of the Tabular List.

J82.89 — Other pulmonary eosinophilia, not elsewhere classified (allergic), J84.111 — Idiopathic interstitial pneumonia, not otherwise specified (interstitial, chronic), J84.112 — Idiopathic pulmonary fibrosis (interstitial, usual), J84.113 — Idiopathic non-specific interstitial pneumonitis (interstitial, non-specific, idiopathic), J84.116 — Cryptogenic organizing pneumonia (cryptogenic organizing), J84.117 — Desquamative interstitial pneumonia (desquamative interstitial), J84.178 — Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere (interstitial, lymphocytic), J84.2 — Lymphoid interstitial pneumonia (lymphoid interstitial), J84.89 — Other specified interstitial pulmonary diseases (organizing), J84.9 — Interstitial pulmonary disease, unspecified (interstitial), J86.0 — Pyothorax with fistula (chest, with fistula), J86.9 — Pyothorax without fistula (chest), J95.4 — Chemical pneumonitis due to anesthesia (aspiration, postprocedural), J95.851 — Ventilator associated pneumonia (ventilator associated), J95.89 — Other postprocedural complications and disorders of respiratory system, not elsewhere classified (resulting from a procedure), J98.09 — Other diseases of bronchus, not elsewhere classified (bronchi), K04.01 — Reversible pulpitis (pulp, pulpal), K04.02 — Irreversible pulpitis (pulp, pulpal, irreversible), K04.6 — Periapical abscess with sinus (apical, with sinus), K04.7 — Periapical abscess without sinus (dental), +258 more

Contextual Map

Every relationship of J85.1 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run J85.1 with these 11 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

  • J86 — Pyothorax[Excludes1](via J85.-): “abscess of lung (J85.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Referenced by Excludes2 notes

Referenced by Code First instructions

Referenced by Code Also instructions (9)

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 283 — Empyema, Lung Abscess [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 04 — Diseases and Disorders of the Respiratory System[MDC crossing]: “Diseases and Disorders of the Respiratory System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 4,000 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027
  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Abscess (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic), lung (miliary) (putrid), with pneumonia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Pneumonia (acute) (double) (migratory) (purulent) (septic) (unresolved), with, lung abscess[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "J85.1 — Abscess of lung with pneumonia." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/j85.1-abscess-of-lung-with-pneumonia

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Abscess of lung with pneumonia

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to J85.1 in its code family, with their registry titles.

View all codes in the J85 family